Estimation of left ventricular operating stiffness from Doppler early filling deceleration time in humans

Shortened early transmitral deceleration times (E-DT) have been qualitatively associated with increased filling pressure and reduced survival in patients with cardiac disease and increased left ventricular operating stiffness (K-LV). An equation relating K-LV quantitatively to EDT has previously been described in a canine model but not in humans. During several varying hemodynamic conditions, we studied 18 patients undergoing open-heart surgery. Transesophageal echocardiographic two-dimensional volumes and Doppler flows were combined with high-fidelity left atrial (LA) and left ventricular (LV) pressures to determine KLV. From digitized Doppler recordings, E-DT was measured and compared against changes in LV and LA diastolic volumes and pressures. E-DT (180 +/- 39 ms) was inversely associated with LV end-diastolic pressures (r = 0.56, P = 0.004) and net atrioventricular stiffness (r = 20.55, P = 0.006) but had its strongest association with K-LV (r = -0.81, P< 0.001). KLV was predicted assuming a nonrestrictive orifice (K-nonrest) from E-DT as K-nonrest = (0.07/E-DT)(2) with K-LV = 1.01 K-nonrest - 0.02; r = 0.86, P< 0.001, DeltaK (K-nonrest - K-LV) = 0.02 +/- 0.06 mmHg/ml. In adults with cardiac disease, E-DT provides an accurate estimate of LV operating stiffness and supports its application as a practical noninvasive index in the evaluation of diastolic function.